Elsevier

Journal of Infection

Volume 50, Issue 2, February 2005, Pages 158-162
Journal of Infection

Case Report
Leptospirosis: a case report of a patient with pulmonary haemorrhage successfully managed with extra corporeal membrane oxygenation

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Abstract

Leptospirosis is a zoonosis of worldwide significance. Pulmonary involvement is common but often mild and of little clinical significance. However, over the last two decades an increasing number of cases have been reported with pulmonary haemorrhage as a prominent feature [Carvalho CR, Bethlem EP. Pulmonary complications of leptospirosis. Clin Chest Med, 2002;23(2):469–78]. These cases are particularly challenging to treat as they often have resistant hypoxaemia despite maximal invasive mechanical ventilation. Consequently, there is a high mortality rate. Here, we present a case of severe leptospirosis complicated by massive pulmonary haemorrhage which was successfully managed by extra corporeal membrane oxygenation (ECMO).

Section snippets

Case report

A 30 year old previously fit and well man presented with a 4 day history of myalgia, nausea, vomiting, anorexia and jaundice. Initial examination showed jaundice with no signs of chronic liver disease. He was apyrexial with a BP of 119/80 mmHg, a pulse of 101 bpm and oxygen saturations of 99% on air. Clinical investigations demonstrated moderate renal impairment, liver impairment, anaemia and thrombocytopenia (Table 1).

Soon after admission the patient had an episode of haemoptysis associated with

Discussion

Leptospirosis is generally acknowledged to be the commonest zoonosis in the world. It is caused by anaerobic spiral bacteria (or spirochete) from the genus leptospira. There are more than 7 distinct species of pathogenic leptospires and at least 250 serological variants or serovars. The most important reservoirs of infection are rodents especially rats and these are responsible for most human infections worldwide.5 Other host animals include sheep, cows, pigs and dogs. Humans become infected

Acknowledgements

Mr H. Killer, Manager ECMO unit Glenfield Hospital Leicester; Mr R.K. Firmin, Co-director ECMO unit Glenfield Hospital Leicester; Dr A. Todd, Consultant Clinical Scientist Carlisle Public Health Laboratory; Dr T.J. Coleman, Consultant Microbiologist Leptosira Reference Laboratory, County Hospital, Hereford; Dr G. Avery, Consultant Radiologist Castle Hill Hospital, Cottingham.

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